Janine Pulford talks to Dr Colin Davidson

On 1 April, as part of national healthcare reforms, 13 Clinical Commissioning Groups (CCG) took over the role of the two Primary Care Trusts (PCT) in Dorset. I spoke to the new Clinical Lead for the East Dorset Locality of NHS Dorset CCG, Dr Davidson, who is a senior partner of the Cranborne Practice, to find out what impact these changes will have on our healthcare.

JP: How would you summarise the changes that will be made?

CD: On a general note, this is a brave new world. We don’t know how it is going to work or how the time commitment is going to be achieved. The balance between giving this new role enough time and involvement and balancing the ever-increasing clinical needs of the day job, which is an intrinsic part of the qualifications for the role will be difficult. Those involved currently are enthusiasts who will make sacrifices to make things work; this might be difficult to maintain if it puts pressure on the workload ‘at home’ and certainly will make recruiting the next generation of CCG Board members tricky. This is for the future, at the moment we in Dorset are in a great position and prepared to maintain the standards of care and improve them where we can.

JP: How do you view your new role?

CD: This is the first time in the history of the NHS that major decisions, over how and where healthcare is provided, will be made by clinicians. Being a GP with daily contact with patients puts us in a unique position to make those decisions to reflect local health needs and to spend the taxpayers money in the most efficient and effective way.
The basis of the new CCG structure, which is based on localities such as East Dorset, should reflect the representative and responsive theme we are aiming for.
NHS Dorset CCG has been working hard over the last year to prepare for the new role of ensuring local health needs are met and these are making a real difference for local communities.
We would like to thank everyone who has been involved in the authorisation process and are looking forward to working with our local partners to improve healthcare for local people. We are building on the legacy of successful PCTs in Dorset and Bournemouth and Poole and are the third largest CCG in terms of population and second largest in financial terms in the country. This will give us stability and the possibility of making big differences, whilst our locality structure ensures being able to respond to local health needs.
There are a number of challenges in Dorset, but by working with our local partners and members of the public we can ensure that the local population receives the best possible healthcare services. We want to design services around patients, prevent ill health and reduce inequalities, ensure sustainable healthcare services and enable care closer to home.

JP: Will GPs have more control over their budgets because of the change?

CD: The CCG will have control over the budget for care APART from care delivered by GP’s themselves – that is passing to a new body called the National Commissioning Board, organised into Local Area Teams.
Dorset PCT and Bournemouth and Poole PCT, who have now been abolished, previously held both of these roles. Responsibility for public health has passed to the local authorities.
Clinically led commissioning will enable us to become more involved in the planning and improvement of local health services, overall we are now responsible for a budget of around £915m and the care of around 760,000 people.
We are looking across the whole community at particular health care pathways to ensure that the services provided are of the highest quality and equitable. This might mean that some services in one locality within Dorset will need more improvements than services in another locality or that because of particular health needs there might be different local priorities. However, the achievement of good practice and value for money services that achieve the best possible outcomes for patients will be set at the same standards across the whole community.
Having clinicians involved at this level allows us to better to represent our patients and their experiences; empowering us to put this feedback and that of other partners and stakeholders at the centre of all commissioning decisions.

JP: Do you see GPs being able to offer a higher quality of healthcare? If so, in which areas do you see the most improvement?

CD: We already do enjoy some of the best healthcare in the country thanks to the legacy left by both PCTs, so maintaining those standards would be a major improvement for a lot of new CCGs. Our aim is to improve where we can and spend the health pound as efficiently as possible; this will be a real challenge because despite the reassurances that there will be no cut to health spending, which is technically true, there is also no allowance for the inflation which normally runs at about 6% in health costs.
This will mean that as demands on the healthcare budget increase and the current healthcare costs more, we will have to make the current level of spending stretch further; this will present us with hard choices to make, ones that we hope our representative structure will allow the widest involvement in making.
Back in March we agreed a 5 year Strategy 2013-18 and the first Annual Delivery Plan for 2013/14. The Strategy sets out the high level ambitions and principles that will govern us from 1 April 2013. We have a very clear set of strategic principles that will guide its work: designing services around patients, preventing ill health and reducing inequalities, ensuring sustainable healthcare services and enabling care closer to home.
We are confident that it has an extremely committed and capable clinical and executive leadership team in place that will ensure that the organisation is seen to be successful in its mission of ‘supporting people in Dorset to lead healthier lives’. There are a number of key areas for service development that we will be focussing on in 2013/14 which are outlined in more detail in the Annual Delivery Plan.
The initial delivery priorities that have been agreed for 2013/14 are: improving dementia diagnosis and services, reducing avoidable emergency admissions and reducing preventable deaths.

JP: Does Dorset’s healthcare compare favourably to other counties?

CD: We are fortunate that in Dorset we enjoy good health. For example average life expectancy across Dorset for both men and women is higher than the national average; whilst fewer people are smoking than other parts of England and rates of early deaths due to heart disease and stroke are also lower than average.
Within Dorset our locality leads the field. We cannot be complacent though as there are some areas in the county where we face challenges such as high rates of smoking in pregnancy, not enough people eating a healthy diet and rates of certain types of cancer being higher than we would like to see.
Our role is to commission (buy) services that best meet the needs of local people including emergency and urgent care; as GPs we are able to use our local knowledge to influence pathways and services in order that they meet needs on a real local level.

JP: What are the aims of Commissioning Groups in the long term?

CD: In the short term, public and patients should not see any differences to the services that are available to them and the way they are accessed. We do however have a clear vision for the continued development and improvement of services.
We expect that there will be very tangible differences and benefits over the next five years with the public recognising and supporting us as a fair and open organisation and one in which it can place great trust.
It is our vision that care will be provided as close to home for patients as it is clinically safe to do so, and that care will focus on prevention – keeping people healthier for longer.
There will be few boundaries within the Dorset care system even though we are using more providers than we have done in the past. The decisions made by us will drive the best possible quality of care and transparency will demonstrate value for money.